Provider Demographics
NPI:1417747304
Name:PAGE, KATHRYN MARILYN (RDN, LD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARILYN
Last Name:PAGE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 DARWIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4225
Mailing Address - Country:US
Mailing Address - Phone:919-609-2658
Mailing Address - Fax:
Practice Address - Street 1:1151 PITTSFORD VICTOR RD STE 220
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3829
Practice Address - Country:US
Practice Address - Phone:315-401-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered